<!--
	作者：641524185@qq.com
	时间：2017-3-2
	描述：申请页面
-->
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<html>

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		<title>企业帮扶申请</title>
		<link rel="stylesheet" href="../css/mdialog.css" />
		<link rel="stylesheet" href="css/firm_apply_edit.css" />
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	<body>
		<div></div>
		<div id="content">
			<div>
				<div class="from">
					<span>首页&gt;</span><span>申请成为帮扶人员&gt;</span><span>企业帮扶</span>
				</div>
				<div class="content">
					<div>
						<div class=""> <span>企业名称：</span><span><input type="text" /></span> </div>
						<div class=""> <span>联系方式：</span><span><input type="text" /></span> </div>
					<!--	<div style="display: none;" class=""><span>微信号：</span><span><input type="text" /></span></div>-->
						<div class=""><span>统一信用代码：</span><span><input type="text" /></span></div>
						<div><span>营业执照附件：</span> <span id="fj_img1" class="fj_img"><img src="../images/icons/card.png"/></span> <span class="upload_fj">上传</span><input dir="user_img" style="display: none;    width: 200px !important;margin-top: 188px;margin-left: 50px;" type="file" name="fj" id="fj1" value="" /></div>
						<div><span>企业地址：</span><span><input type="text" /></span></div>
						<div><span>企业电话：</span><span><input type="text" /></span></div>
						<div><span>法人姓名：</span><span><input type="text" /></span></div>
						<div><span>证件:</span><span>
							<select name="">
								<option value="1">身份证</option>
								<option value="2">其它类型</option>
							</select>
						</span></div>
						<div><span>证件号：</span><span><input type="text" /></span></div>
						<div><span>身份证附件：</span> <span id="fj_img2" class="fj_img"><img src="../images/icons/default_card.png"/></span> <span class="upload_fj">上传</span><input dir="user_img" style="display: none;    width: 200px !important;margin-top: 188px;margin-left: 50px;" type="file" name="fj" id="fj2" value="" /></div>
						<div><span>备注：</span><span><input type="text" /></span></div>
						<span class="submint">
							提交
						</span>
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